Medication Summary
Most medications used to treat hypoglycemia are hormonal and either replace a hormonal deficiency (ie, a cortisol or growth hormone deficiency) or suppress excess hormone production (octreotide). Diazoxide is an antihypertensive agent that also suppresses insulin secretion.
As previously mentioned, in infants with one of several disorders (eg, ketotic hypoglycemia, glycogen-storage disorder, free fatty acid metabolism defect, mild hyperinsulinism), hypoglycemia can be prevented with frequent feedings using a specifically designed diet, but when feeding is inadequate because of GI problems or other illnesses, parenteral dextrose can be used to obtain a rapid response. Fructose must be avoided in children with fructose diphosphatase deficiency.
Insulin secretion inhibiting agents
Class Summary
Various mechanisms may alter insulin secretion. Diazoxide inhibits pancreatic secretion of insulin, stimulates glucose release from the liver, and stimulates catecholamine release, which elevates blood glucose levels. Octreotide is a peptide with pharmacologic action similar to that of somatostatin, which inhibits insulin secretion.
ATP-sensitive potassium channels (composed of the sulfonylurea receptor [SUR] and the potassium channel pore protein [Kir6.2]) function abnormally in persistent hyperinsulinemic hypoglycemia of infancy. These channels initiate depolarization of the beta-cell membrane and opening of calcium channels. The resultant increase in intracellular calcium triggers insulin secretion. Calcium channel blockers block the action of these calcium channels, decreasing insulin secretion. Nifedipine is the only calcium channel blocker for which data have been reported in clinical trials in humans.
Diazoxide (Proglycem)
Diazoxide is a first-line medical treatment for hyperinsulinism. This agent inhibits insulin release from the pancreas.
Octreotide (Sandostatin)
Octreotide, a synthetic polypeptide, is usually the second-line therapy for hyperinsulinism. It inhibits the release of many biologically active substances, including insulin.
Nifedipine (Adalat, Procardia, Afeditab)
Nifedipine acts to block calcium influx, which stimulates insulin secretion.
Dextrose and glucose stimulators
Class Summary
Promptly activation of gluconeogenesis is achieved with glucagon. Emergent elevation of blood glucose levels requires IV dextrose.
Dextrose (D-glucose)
Dextrose is used to promptly elevate serum glucose levels. It is a monosaccharide that is absorbed from the intestine and is then distributed, stored, and used by the tissues.
Glucagon (GlucaGen, Gvoke)
This is the first-line home treatment for severe hypoglycemic reactions in patients with diabetes. Glucagon promotes glycogenolysis and gluconeogenesis, resulting in elevation of blood glucose levels. Glucagon may cause vomiting for 4-6 hours after administration.
Glucagon may be useful when intravenous (IV) access for dextrose administration is problematic. This agent may be administered as part of emergency medical services (EMS) protocol in patients with altered mental status and no IV access. It is also available as a ready-to-use subcutaneous (SC) solution in prefilled syringes or an autoinjector.
Glucagon intranasal (Baqsimi)
Glucagon intranasal activates hepatic glucagon receptors that stimulate cAMP synthesis. This action accelerates hepatic glycogenolysis and gluconeogenesis, causing an increase in blood glucose levels. Preexisting hepatic glycogen stores are necessary for the drug to be effective in treating hypoglycemia. It is indicated for severe hypoglycemic reactions in adults and children aged 4 y or older with diabetes.
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Normal hypoglycemic counterregulation.
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Interpretation of the critical sample.
